Moore Anatomy Flash Cards

Thorax 1.37

Veins of the Heart

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Veins of the Heart

1. anterior cardiac vein
2. great cardiac vein
3. small cardiac vein
4. oblique vein of the left atrium
5. coronary sinus
6. left marginal vein
7. left posterior ventricular vein
8. middle cardiac vein
Most venous drainage of the heart empties into the coronary
sinus before it reaches the right atrium. Anterior cardiac veins
end directly in the right atrium. The smallest cardiac veins
begin in capillary beds and empty directly into the heart
chambers (primarily the atria).

Reversal of flow in the anterior and smallest cardiac veins
may allow luminal blood to flow directly to the myocardium,
providing some collateral circulation.

© 2014 Lippincott Williams & Wilkins

Thorax 1.38

Conduction System of the Heart

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Conduction System of the Heart

1. sinuatrial node
2. atrioventricular node
3. atrioventricular bundle
4. muscular interventricular septum
5. bundle branches (right and left)
6. anterior papillary muscle
7. septomarginal trabecula
8. subendocardial branches
The sinuatrial node is the pacemaker of the heart because it
initiates muscle contraction and determines the heart rate.

Damage to the conduction system of the heart (often by
compromised blood supply) leads to disturbances of muscle
contraction. Damage to the atrioventricular node results in
heart block because the atrial excitation wave does not reach
the ventricles. The ventricles therefore contract at their own
slower rate. In some patients with heart block, an artificial
cardiac pacemaker is inserted subcutaneously. The pacemaker
is connected directly to the trabecula carneae of the right
ventricle.

© 2014 Lippincott Williams & Wilkins

Thorax 1.39

Mediastinum, Right Side

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Mediastinum, Right Side

1. longus coli
2. esophagus
3. anterior scalene
4. posterior intercostal vein and artery
5. intercostal nerve
6. azygos vein
7. right vagus nerve
8. sympathetic trunk
9. right phrenic nerve
10. pericardiophrenic artery
11. rami communicantes
12. greater splanchnic nerve
13. azygos vein

Longus Coli
• superior attachment: anterior tubercle of the atlas; bodies of

C1–C3 and transverse processes of C3–C6 vertebrae
• inferior attachment: bodies of C5–T3 vertebrae; transverse

processes of C3–C5 vertebrae
• innervation: anterior rami of C2–C6 spinal nerves
• main action: flexes neck; rotation toward opposite side if

acting unilaterally

© 2014 Lippincott Williams & Wilkins

Thorax 1.40

Mediastinum, Left Side

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Mediastinum, Left Side

1. supreme intercostal artery
2. sympathetic trunk
3. intercostal vein, artery, and nerve
4. common carotid artery
5. internal thoracic artery
6. thoracic duct
7. esophagus
8. left superior intercostal vein
9. arch of aorta
10. vagus nerve
11. left phrenic nerve
12. accessory hemiazygos vein
13. ligamentum arteriosum

Using an endoscope (mediastinoscope), surgeons can see
much of the mediastinum and conduct minor surgical proce-
dures. The endoscope is inserted through a small incision at
the root of the neck.

Physicians sometimes observe widening of the mediastinum
when viewing radiographs. Any structure may contribute to
widening of the mediastinum; it is typically a sign of some
pathological process within the region.

© 2014 Lippincott Williams & Wilkins

Thorax 1.41

Superior Mediastinum,
Superficial Dissection

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Superior Mediastinum,
Superficial Dissection

1. brachiocephalic artery
2. right brachiocephalic vein
3. esophagus
4. left common carotid artery
5. left subclavian artery
6. thymus
7. internal thoracic artery and vein
8. cut edge of fibrous pericardium
The thymus regresses after puberty and is largely replaced by
fat and fibrous tissue.

In the infant, the thymus is a prominent feature of the supe-
rior mediastinum. In some infants, the thymus may compress
the trachea. Even after the thymus becomes diminished after
puberty, it still continues to produce T lymphocytes.

© 2014 Lippincott Williams & Wilkins

Thorax 1.42

Superior Mediastinum,
Thymus Removed

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Superior Mediastinum,
Thymus Removed

1. recurrent laryngeal nerves
2. right vagus nerve
3. phrenic nerve
4. internal thoracic artery
5. right brachiocephalic vein
6. left common carotid artery
7. left subclavian artery
8. ligamentum arteriosum
9. cut edge of fibrous pericardium
The fibrous pericardium fuses with the proximal aspects of the
great vessels.

The distal part of the ascending aorta receives a strong thrust
of blood when the left ventricle contracts. Because the distal
part of the ascending aorta lacks reinforcement from fibrous
pericardium, an aneurysm (a localized dilation) may develop.

© 2014 Lippincott Williams & Wilkins

Thorax 1.43

Arch of the Aorta

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Arch of the Aorta

1. right vagus nerve
2. right recurrent laryngeal nerve
3. anterior scalene muscle
4. left phrenic nerve
5. left common carotid artery
6. left recurrent laryngeal nerve
7. brachiocephalic trunk
8. left subclavian artery
9. left vagus nerve
10. ligamentum arteriosum

The usual pattern of branches of the arch of the aorta is pres-
ent in approximately 65% of people. Variations in the origin of
the branches are fairly common.

Right common Left common RC LC
carotid (RC) carotid (LC) RS

Right Left BT LS
subclavian (RS) subclavian RS
(LS) RC
Brachiocephalic
trunk (BT) RC LC Left BT LC
RS vertebral LS
Arch of
aorta artery BT

Ascending LS
aorta
BT

© 2014 Lippincott Williams & Wilkins

Thorax 1.44

Superior Mediastinum,
Tracheal Bifurcation

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Superior Mediastinum,

Tracheal Bifurcation

1. left vagus nerve
2. left recurrent laryngeal nerve
3. thoracic duct
4. trachea
5. arch of azygos vein
6. arch of aorta
7. bronchial arteries
8. right main bronchus
9. left main bronchus
10. root of lung
11. esophagus

In coarctation of the aorta,

the arch of the aorta, or

descending aorta, has an

abnormal narrowing (stenosis)

that diminishes the caliber of

the aortic lumen, producing an

obstruction to blood flow to the

inferior part of the body. The

most common site is near the

ligamentum arteriosum. Coarctation of the aorta

© 2014 Lippincott Williams & Wilkins

Thorax 1.45

Superior Mediastinum, Nerves

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Superior Mediastinum, Nerves

1. right recurrent laryngeal nerve
2. right vagus nerve
3. left recurrent laryngeal nerve
4. left vagus nerve
5. esophagus
6. cervical cardiac nerves
7. cardiac plexus
8. ligamentum arteriosum
9. lymph nodes
10. anterior pulmonary plexus
11. right pulmonary artery

The recurrent laryngeal nerves supply all intrinsic muscles of
the larynx except one, the cricothyroid.

Any diagnostic procedure or disease process in the superior
mediastinum may injure the recurrent laryngeal nerves and
affect the voice. The left recurrent laryngeal nerve, as a result
of its course through the region, may be compromised in a
bronchogenic or esophageal carcinoma, enlargement of medi-
astinal lymph nodes, or an aneurysm of the arch of the aorta.

© 2014 Lippincott Williams & Wilkins

Thorax 1.46

Esophagus

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Esophagus

1. esophagus
2. thoracic duct
3. arch of aorta
4. left bronchi
5. descending aorta
6. right crus of diaphragm
7. esophageal hiatus
8. left crus of diaphragm
9. chyle cistern
10. aortic hiatus
The esophagus is compressed by three structures: (1) the arch of
the aorta, (2) the left primary bronchus, and (3) the diaphragm.

The sites of compression of the esophagus by adjacent struc-
tures indicate where swallowed foreign objects are most likely
to lodge and where a stricture may develop after accidental
drinking of a caustic liquid.

© 2014 Lippincott Williams & Wilkins

Thorax 1.47

Thoracic Duct

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Thoracic Duct

1. jugular trunk
2. right lymphatic duct
3. subclavian trunk
4. right venous angle
5. bronchomediastinal trunk
6. left brachiocephalic vein
7. left superior intercostal vein
8. azygos vein
9. thoracic duct

Variations in the thoracic duct are common because of its
embryological formation. Occasionally, there are two lym-
phatic ducts for a short distance.
Laceration of the thoracic duct during surgical or investiga-
tive procedures of the thorax results in lymph escaping into
the thoracic cavity. The fluid may be removed by a needle tap
or thoracocentesis, and, in some cases, it may be necessary to
ligate the duct.

© 2014 Lippincott Williams & Wilkins

Thorax 1.48

Azygos System of Veins

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Azygos System of Veins

1. left brachiocephalic vein
2. left superior intercostal vein
3. superior vena cava
4. azygos vein
5. accessory hemiazygos vein
6. hemiazygos vein
The highly variable azygos system of veins drains the back,
thoracoabdominal walls, and thoracic viscera.

The azygos system of veins offers an alternative route for
venous drainage from the thoracic, abdominal, and back
regions when obstruction of either the superior or inferior
vena cava occurs.

© 2014 Lippincott Williams & Wilkins

2 • Abdomen

2.1 Anterior Abdominal Wall, Superficial Dissection
2.2 Anterior Abdominal Wall, Musculature
2.3 Trunk
2.4 Drainage of the Anterior Abdominal Wall
2.5 Neurovascular Elements, Penis and Spermatic Cord
2.6 Inguinal Canal of the Female
2.7 Posterior Aspect of Anterolateral Abdominal Wall
2.8 Inguinal Region of the Male
2.9 Inguinal Region of the Male, Musculature
2.10 Spermatic Cord
2.11 Scrotum
2.12 Anterior Abdominal Wall, Deep Dissection
2.13 Testis and Epididymis
2.14 Peritoneal Cavity
2.15 Greater Omentum
2.16 Posterior Wall of Peritoneal Cavity
2.17 Stomach and Omenta
2.18 Omental Bursa
2.19 Porta Hepatis and Gallbladder
2.20 Stomach
2.21 Diaphragm, Inferior View
2.22 Internal Aspect of the Stomach
2.23 Duodenum, Anterior View
2.24 Duodenum, Posterior View
2.25 Superior Mesenteric Artery
2.26 Appendix
2.27 Inferior Mesenteric Artery
2.28 Colon
2.29 Spleen
2.30 Pancreas